Chat with us, powered by LiveChat

Making Coding Decisions (Before the Craziness!)

by Gail I. Smith, MA, RHIA, CCS-P

Let’s go back to the early years….1973 to be exact. I began my HIM career that year and discovered a love of coding. This was before encoding software, DRGs, HIPAA, APCs, or Official Coding Guidance.

There were two coders in the department of a 273-bed hospital in Cincinnati, Ohio, one was inpatient and one was outpatient. The inpatient coder, W., would come around the corner with a 4” thick paper inpatient medical record and ask me, the outpatient coder, “how would you code this?” We both enjoyed the back-and-forth discussion that reminded me of a type of coding grand rounds. It started with why the patient was admitted and what happened during the stay. The conclusion would be how we would code the case. Sometimes we encountered gray areas where we disagreed. How did we decide the final coding plan? We based our decisions on the clinical picture, coding guidelines, and how the classification system worked. From these grand round sessions, we were able to transfer our “system of decision-making” to other cases. I was proud of the work we did to promote quality coding and consistent data.

Fast forward to the 1980’s and along came DRGs and publications providing coding guidance that sometimes made us question our previous coding decisions. We decided not to blindly follow this advice if it did not have rationale that was supported by clinical knowledge or violated coding guidelines and how the classification system was designed.

Fast forward again to 2018 and the current state of coding. Coding professionals express their frustration with being audited at every turn, overregulated, and forced to adhere to guidance that sometimes makes no sense. Somehow, we lost our way.

I have a vision on how to move forward, but that will be shared in a series of future blogs. In the meantime, what is your strategy for reconciling conflicts between coding advice and the rules (Official Guidelines and Classification Conventions/Principles) which govern coding?

What ever happened to W? She went on to become a top-notch coding consultant because she followed the grand round system.


eLearning Library Subscription
Unlimited access to over 50 courses, assessments, and training curriculums designed to enhance job-specific, self-paced learning for one full year. Special pricing available for Groups. Train your entire team! Learn more here.

About the Author

Gail Smith, MA, RHIA, CCS-P
Gail I. Smith, President of Gail I. Smith Consulting, is a health care consultant with over 30 years experience in the field of coding, education and health information management (HIM). Gail focuses on ICD-10-CM/PCS education with developing online courses, presenting workshops, and performing documentation reviews. She has authored several coding books for CPT and ICD-10-CM and is an AHIMA approved ICD-10-CM/PCS trainer and Academy faculty member.

5 thoughts on “Making Coding Decisions (Before the Craziness!)

  1. Linda Parks - September 11, 2018 at 8:14 pm

    Hi Gail
    Just wanted to say that your message brought back a flood of memories. I started in HIM/coding in 1973 too, and had a similar experience in grand rounds and collaborative decision making in coding back in the early days. In the same spirit if you ever want to brainstorm, I would be happy to join you in the effort. Guess I am nostalgic — miss the old days/ways sometimes.

  2. Linda Dawson, RHIT, CCS - September 11, 2018 at 8:53 pm

    Love this article. I started coding in l974 and agree with everything you said. Coding is not the easy job it used to be. We have to understand a lot more anatomy, disease processes, procedures, and now the clinical indicators for numerous diseases. We have to be detectives and validators of every diagnosis in the chart to make sure we should code them. Gone are the days of coding and dropping a chart in one process. Now we have to wonder who is looking at it on the back end for patient safety and quality, clinical validation of sepsis or acute resp failure, etc.Fun and mentally challenging times for sure

  3. Deborah Gardner Brown - September 12, 2018 at 11:38 am

    We have pandemic of controversial auditing (concepts) being thrust into our daily decision making for ethical and compliant coding. Enjoyed reading your excerpt on coding craziness.
    Would like to connect with you by phone some time to share trends in my region.

  4. K. Sue Smith, RHIT - September 12, 2018 at 11:56 am

    Hi Gail,
    That was a great article and it is always so good to see your face and learn something more from you. I think back to when I first started in this business back in 1997 after leaving LPAC to pursue my education and career and it amazes me how much has changed since only then.

    I hope you are doing well.


  5. Tammy Sullivan - September 15, 2018 at 11:42 am

    This was a good article Gail . I agree with you that coding has definitely changed over the years . I attended a seminar that you and Lynn Kuehn had in Orlando Florida a few years ago . It was one of the best ones that I have been to . I hope you are doing well . Tammy